| NPI | 1164823035 |
|---|---|
| Former Name | CANDICE LESLIE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TN 9815) |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2019-06-14 |